Functional Elements Of Clinical Pharmacy Practice

Functional Elements Of Clinical

Pharmacy Practice

PHCL 471

Nouf M Aloudah


Pharmacy Practice

• Clinical pharmacy have evolved and still evolving in a variety of ambulatory and institutional pharmacy settings

• Many hospitals now providing medication histories, patient drug counseling, patient drug monitoring, and drug information services

• Specialized clinical services such as clinical pharmacokinetics, nutritional support, clinical toxicology


Pharmacy Practice

Historical development of clinical pharmacy

• Definitions of clinical pharmacy:

▫ Clinical pharmacy practice as a practice in which the pharmacist utilizes his professional judgment in the application of pharmaceutical sciences to foster the safe and appropriate use of drugs, in or by patients, while working with members of the health care team


Pharmacy Practice



▫ American Association of Colleges of Pharmacy : clinical pharmacy is that area within the pharmacy curriculum which deals with patient care with emphasis on drug therapy. Clinical pharmacy seeks to develop a patient oriented attitude. The acquisition of new knowledge is secondary to the attainment of skills in inter-professional and patient communication


Pharmacy Practice



▫ Others: the primary mission of clinical pharmacy is the promotion and assurance of rational and safe drug therapy, the other health care practitioners share this goal with clinical pharmacists, though this is not their sole, intensive concern!


Pharmacy Practice



▫ Clinical pharmacy is a health science specialty whose responsibility is to assure the safe and appropriate use of drugs in patients through the application of specialized knowledge and function in patient care, and which necessities specialized education and/or structure training. It requires use of judgment in the collection and interpretation of data, patient- specific involvement, and direct inter-professional interactions


Pharmacy Practice



▫ In summery clinical pharmacy involves the application of drug knowledge on behalf of the patient, while considering the patient’s disease conditions and his need to understand drug therapy

▫ The practice requires a close association between the pharmacy and the patient, physician, and other providing health care services


Pharmacy Practice


• Factors influencing the development of clinical pharmacy:

1.

Unresponsiveness of health care delivery system to public needs

2.

Absence of a single discipline with broad responsibility for drug use control

3.

Overeducated and underutilized pharmacists

4.

Diminished demand for the traditional compounding skills of pharmacists

5.

Major unresolved problems with drug use in society

6.

Inadequate drug knowledge on the art of health professionals and patients


Pharmacy Practice



▫ In the past, the pharmacist has often isolate himself from the patient and from other health practitioners

▫ The health professions are now facing the problem of how to design a health care system which will provide health maintenance for all people at the most reasonable cost

▫ It is becoming clear that such a system will depend on close cooperation among all health professions

▫ Clinical pharmacy stands to play a major role in the attainment


Pharmacy Practice



▫ All of the health disciplines have involved to some degree with drugs, but no particular discipline has exercised a broad responsibility for the total drug use process

▫ This resulted I drug misuse, overuse, abuse and in serious unwanted drug effects


Pharmacy Practice



▫ All of the health disciplines have involved to some degree with drugs, but no particular discipline has exercised a broad responsibility for the total drug use process

▫ This resulted In drug misuse, overuse, abuse and in serious unwanted drug effects

▫ Led to the thinking that there was a need for one discipline to assume broad leadership and responsibility for the safe and appropriate use of drugs in society


Pharmacy Practice



▫ 1960s recognized that most pharmacist were overeducated!

▫ The climate was right for a major change in pharmacy practice


Pharmacy Practice



▫ Educators and practitioners began to press for change in pharmacy practice and education


Pharmacy Practice

Clinical pharmacy functions and services

Includes one or more of those activities as general or specialized

General clinical pharmacy functions and services

• Providing drug information to other health professionals

• Aimed to

• Defining therapeutic goals and endpoints of drug therapy

• Selecting the most appropriate therapeutic agent for drug therapy

• Prescribing the most appropriate drug regimen

• Monitoring the effect of drug therapy based upon indices of effect and

• Selecting methods for drug administration


Pharmacy Practice


▫ Significant improvement

▫ Drug information and poison centers


Pharmacy Practice


▫ Obtaining patient medication histories and using patient medication profiles to assure proper drug utilization

 Minimum it should contain ………

 Additional drug specific monitoring information may be obtained on patient files


Pharmacy Practice


▫ Monitoring drug therapy

▫ Effectiveness, ineffectiveness, ADR, toxicity ect

▫ Food and drug administration adverse reaction reporting programs

▫ Medication profile, laboratory data, physical examination data, nurses’ and physicians’ notes and even the results of ECG, X ray are used monitor drug therapy response


Pharmacy Practice


▫ Providing patient education and medication counseling


Pharmacy Practice


▫ Providing disease screening, monitoring, and maintenance care for patients with chronic diseases


Pharmacy Practice


▫ Participation in the management of emergency medical care


Pharmacy Practice


▫ Serving as a health information and education source for the public


Pharmacy Practice


▫ Participation in drug use review and patient care audits


Pharmacy Practice


▫ Providing in-service education for physician, nurses, and other health professionals


Pharmacy Practice

Specialized functions and services:

▫ Nutritional support services

▫ Formal (written) drug therapy consultations

▫ Clinical pharmacokinetics services

▫ clinical toxicology services

▫ Clinical drug investigations


Pharmacy Practice

• Franck’s legacy40 years of clinical pharmacy

• clinical pharmacy 30 years later !

• clinical pharmacy and medication safety

• scope of international clinical pharmacy

How To Get Involved in Medical

Rounds

PHCL 471

Nouf Aloudah

Clinical Pharmacy Lecturer

King Saud University

How To Get Involved in Medical Rounds

• Rationale For The Pharmacist’s Participation In

Rounds

A.

IMPROVED PATIENT CARE

1.

Promotion Of Rationale Drug Therapy

1.

Evaluate appropriateness of the selected drug

2.

Calculating the dosage consistent with the renal and hepatic function of the patient

3.

Determining an acceptable dosage interval that will ensure therapeutic benefit and compliance

4.

Preventing drug related adverse effects



Rounds

2.

Provision Of Drug Information



Rounds

B.

EDUCATION OF THE PATIENT AND THE

HEALTH CARE TEAM

1.

Educating and interacting with the patient

2.

Educating the pharmacist

3.

Educating other health professionals

4.

Educating patients and hospital staff about pharmacy services


• Types Of Rounds

▫ Medical teaching service rounds

▫ Private physician rounds

▫ Special unit rounds

▫ Interdisciplinary rounds

▫ Pharmacy rounds


• Factors In The Pharmacist’s Selection Of a

Rounding Team

▫ Time available

▫ Ability to work with the physician

▫ Continuity of patient care

▫ Personal interests

▫ Acceptance by the rounding team


• Pharmacist’s Preparation For Rounds

A.

Self preparation

 Become familiar with appropriate references

 Keep abreast of current research

 Determine appropriate patient monitoring criteria

 Understand and maintain the rounding schedule



B.

Specific Planning

 Develop a monitoring profile and/or patient log sheet

 Determine the best method for communicating with the rounding team

 Reassess specific drug therapy periodically

 Prepare lectures on related drug topics

 Work out a system where you can be contacted readily

 Make certain that other pharmacists and supportive personnel understand what you are doing



C.

Preparation of specific monitoring aids and a daily rounding checklist

Monitoring Drug Therapy

PHCL 471

Nouf M Aloudah


College of pharmacy



• most important clinical function of the pharmacist


• is a process which encompass all those functions necessary to ensure appropriate, safe, efficacious and economical drug therapy to the patient

• functions


• Rationale

• literature identified some significant problems with regards to the drug therapy of patients due to increasing no of available drugs

• problem includes…


• Use Of Medical Records

• you should be familiar with patients medical records

• types of patient records

▫ the source oriented record

▫ the problem oriented record

 data base section

 problem list

 plan

 progress notes

 discharge summery


• Setting Priorities

• do not have staff to be able to monitor each and every patient receiving drug therapy

• at risk of developing adverse effects from drug therapy should be identified

▫ patient selection by disease state

▫ patient selection by drug therapy


• The Process Of Monitoring Drug Therapy

A.

problem orientation off patient data



B.

determination of the appropriateness of specific therapy



C.

development of specific therapeutic goals



D.

development of specific monitoring parameters



E.

identification of problems



F.

development of alternatives or solutions to problems



G.

communication of findings and recommendations


• Developing A Plan Of Self Study

Teaching And Counseling

Patients About Drugs

PHCL 471

Nouf M Aloudah


College of Pharmacy


Teaching And Counseling Patients

About Drugs

Introduction

• Practiced several years and years

• Innovative ways

• Limited by financial constrains and the willingness of pharmacists to participate in this activities

• Understanding the need is basic for designing quality programs


About Drugs

• Who should teach and counsel?

▫ Not drug information you want to change behavior

▫ Noncompliance occur in 30-50%

▫ Oral or written intervention by the pharmacist improved compliance


About Drugs


▫ Physician?

 First to see pt

 They remember 20-40 of what been told to them

 Multiple demands on them


About Drugs


▫ Nurse?

 Happened in many institutions

 Identify it to prevent duplication

 Approached positively they will welcome

 Provide educational material

 Administer drug daily, it is a good chance!


About Drugs


▫ Pharmacist?

 Last to see the pt

 Needs to develop skills

 Ethical responsibility

 Obtain data to support the program


About Drugs

• Who should be taught and counseled?

▫ Time and manpower determine who one can teach and what type of educational programs

 pt referred by physicians

 Pt with specific disease status

 Pt receiving specific drug classes

 Elderly populations

 Pediatric populations

 Pt being discharged


About Drugs

• How to teach and counsel?

▫ Pt education not information

▫ Not only to teach but to negotiate a regimen

▫ Assessment phase

 Open ended questions

 Reflective questions

 Closed ended questions

 Suggestive questions

▫ Planning and implementation phase

 Verbal communication

 Nonverbal communication

 listening

▫ Evaluation phase


About Drugs

• What to teach about drugs?

▫ Major points, helpful to identify which information specific to retain

▫ Drug should be researched toughly prior to session

▫ Planned presentation to ensure covering important points


About Drugs

• What to teach about drugs?

1. Description and strengths

2. Use and schedule

3. Mechanism of action

4. Effect on life style

5. Storage

6. Potential adverse effects

7. Potential drug or delivery interactions


About Drugs

• Where to teach and counsel?

▫ Private setting without interruptions

▫ Better recall if counseled in private areas

▫ At least 15 min per session


About Drugs

• Where to teach and counsel?

▫ Inpatient setting

 During hospital stay, at the time of discharge

▫ Outpatient setting


About Drugs

• Teaching aids?

▫ Printed materials

▫ Audiovisual materials

▫ Compliance aids

▫ Educational display

Providing drug information to health professionals

PHCL 472

Nouf M Aloudah

Clinical Pharmacy lecturer



• Who needs to know what?

• Specific categories of drug information questions and how these questions differs among various types of health professionals


• Drug information categories

• If you know question type you will understand the need, aids in selecting references


Most questions falls into one of the following categories

• Adverse drug reactions

Common side effects to ADR to be reported to FDA

• Ex

▫ Which sedative, …………. Or ……… causes the least amount of hangover?

▫ If the pt allergic to ………. Can we safely administer

………?

▫ Has leukemia ever been associated with the use of …?



• availability

Product- oriented questions about old and new drugs

• Ex

▫ Has …. Been released yet?

▫ Who makes …?

▫ What strength doses …. Come in?



• Drug interaction

Drug-drug, drug- food, drug- laboratory interactions

• Ex

▫ Can … be used safely with …?

▫ Dose food affect the absorption of …?

▫ Will administering … cause a change in the serum level of …?



• Foreign drugs

• Ex

▫ An article about … recently appeared in a British journal. What is it?

▫ A patient recently returned from europ with a Rx of … what its equivalent?



• identification

• Ex

▫ What is this tablet?

▫ What are the ingredients in …?

▫ Is an … OTC product?



• Pharmaceutical calculations

• Ex

▫ How many mEq of calcium are in 500 mg of …?

▫ How fast should a … drip be run to deliver 5 mcg

/min?



• Toxicity and poisoning

Overdose or toxic exposures are in this category

• Ex

▫ what symptoms can be expected in a pt who has taken a bottle of ….?

▫ Should a child who has ingested … receive ipecac?


Needs of health professionals

• Each one may ask any of the question mentioned but each has a different need

• Physicians:

Questions related to prescribing or monitoring drug therapy

• Nurses:

Drug administration, adverse drug reaction

• Pharmacists:

Numerous questions need access to resources


Drug information sources

• Basic drug information reference library

References which contain information on ten categories

• Extent depends on funding

▫ “Must have”

▫ “Should have”

▫ “Nice to have”


• “Must have reference”: tertiary references

(textbooks) five basic types:

1.

Product oriented

2.

Drug oriented

3.

Disease oriented

4.

Specific topic

5.

specialty


• Product- Oriented References

Best source for availability and identification questions

• Ex

▫ Facts and comparison: product monographs, comparative information on similar products, cost index

▫ Handbook of nonprescription drugs: contain monographs on various classes of nonprescription drugs, compare contents of products in similar classes


• Drug- Oriented References

Stronger emphasis on the particular drug or drug class than on the product

• Ex

▫ Martindale, the extra pharmacopeia published every five years, contain extensive referenced monographs on drugs and drug classes with international coverage excellent source for adverse reactions, therapeutic and pharmacology


• Disease- Oriented References

Chapters on disease states, very useful for questions in the therapeutics and pharmacology category from disease perspective

• Ex

▫ Applied therapeutics published every 3-4 years


• Specific topic references

Compatibilities of IV drugs, DI, and poisoning

• Ex

▫ Handbook of injectable drugs

▫ Handbook of poisoning

▫ Applied pharmacokinetics


• Specialty references

Under “should be” references


• a “must have” list would be incomplete without primary references or journals

• Ex

▫ American journal of hospital pharmacy


• Should have “ references

After selection of your “must have” reference the others can be considered “should have”

• Specialty references could be considered “should have”

▫ Cancer chemotherapy

▫ Pediatrics

▫ infectious disease

• At least one journal which discuss drugs and drug therapy

• Ex

▫ The medical letter

▫ pharmacotherapy


• “nice to have” references

Secondary source of drug information

• Ex

▫ Clin -alert

▫ IOWA drug information services

•

Pharmaceutical manufactures


Answering questions

• Knowing the real question

▫ What the requester actually wants to know, classify the requester (physician, nurse, pharmacist) and obtain the necessary background information

▫ What is the dose of …?possibilities are endless

▫ Patient information: age, weight…, disease condition…, whole medical history ! extent of the question asked



• Systemic search

▫ Which category?

▫ which reference? update?

▫ Not found in tertiary references go to secondary references



• Communicate an answer

▫ Timing ex administration maximum 6 hours

▫ Brief , concise, accurate

▫ Verbally

▫ Sometimes written, should be well organized, grammatically correct, timely manner



• Follow up

▫ When possible with certain types of questions especially directed to pt care

▫ Ex adverse reaction



• As more questions are asked the more confidence will grow

• The key to increase the clinical role is exposure


Drug information support to hospital committee

Participation increase exposure and aids in recognition of our role

• The P & T committee

• It is a policy recommending body, several functions can be supported by DI

• Evaluating drug for inclusion in the hospital formulary

• What to includes?

• Decision is more difficult, keep it simple



• Decision is more difficult, keep it simple

• Educational function of the committee



• DUR

▫ Frequently asked questions may pinpoint areas for which drug use review studies are needed

• Others

▫ Human research committee, infection control committee, nutrition committee


Vehicles for providing drug information

• Pharmacy newsletter

• Provide information and help in pharmacist recognition as drug information source

• Selecting topics:

▫ drug information

▫ P & T committee actions

▫ DUR programs

▫ Journal articles

• Writing for a particular audience

• Publication and disterbution

• Verbal presentation


Vehicles for providing drug information

• Verbal presentation

▫ Formal or informal lectures, in service presentations, ground rounds,

▫ Starts by the pharmacists

▫ Topics

▫ Particular audience

▫ Teaching techniques and strategies: length, formality, objectives, instructional aids, handouts, summery


In summery

• Drug information is a component of all clinical pharmacy services

• Providing DI can be rewarding by

▫ Fully utilized our knowledge

▫ We become more active members of the team

▫ It can open doors to other clinical functions

▫ Achieving rational therapeutics leading to improved pt care

• Best wishes!

Functional Elements Of Clinical Pharmacy Practice

Functional Elements Of Clinical

Pharmacy Practice

How To Get Involved in Medical

Rounds

Monitoring Drug Therapy

Teaching And Counseling

Patients About Drugs

Providing drug information to health professionals

•

Related documents

Products

Support

Functional Elements Of Clinical Pharmacy Practice